“What’s the very first thing you want to know before you are about to see a new patient referred for cataract surgery?”
That’s often the first question we ask our student externs on the first day of their rotation at Pacific Cataract and Laser Institute.
Our practice has long been a learning site for externs and residents as well as experienced optometrists and even optometry school faculty. No matter their program – externship, residency or fellowship – we teach them as though they are newly hired doctors at our practice, soon to be responsible for important decisions.
What’s the surgery plan? What type and power of IOL will be used? Which eye first, and why? Are there co-existing problems that may lead to a complication or prevent a good outcome? If so, do those need to be addressed first? Do additional pre- or postop medicines need to be prescribed? Perhaps most important, should we even do surgery at all?
And while very few will ever have careers at a referral-only medical and surgical optometric comanagement center like PCLI, we want them to thoroughly understand how our responsibilities and roles are different compared to optometrists in primary care.
By the time we ask that question, our patients have been thoroughly quizzed, measured, examined and counseled by highly trained technicians, and it’s all documented in the electronic health record. Calculations of the power of several types of IOLs that will correct that patient’s eyes are complete. What’s left for the optometrist to ask? Plenty.
The answer that most externs give to that question is usually intelligent and thoughtful, if understandably hesitating and quiet: What’s their chief complaint? Which eye is bothering them the most? Have they had prior eye problems or surgery?
All good answers. But this is the answer: What is it that their referring doctor wants us to do?
We look at the referral first, before anything else. We know our referring doctors well individually, their specific preferences, and the meaning of what is included or not included in both their written and spoken communications. What has the referring doctor told the patient about their condition and any other problems that can limit vision after surgery? Have toric or multifocal IOL options been discussed and decided on? Has a target postop refractive error been determined? Which eye will be treated first, and when will the second eye be scheduled?